패혈성 쇼크 환자의 좌심실 이완기 기능장애와 트로포닌 테스트의 관계
Association between high-sensitivity troponin test and tissue Doppler assessment of left ventricular diastolic dysfunction in critically ill septic patients
김무열, 김준성, 김윤정, 안신, 김원영,
소속 상세정보
김무열 ( Kim Mu-Yeol )
울산대학교 의과대학 서울아산병원 응급의학과
김준성 ( Kim June-Sung )
울산대학교 의과대학 서울아산병원 응급의학과
김윤정 ( Kim Youn-Jung )
울산대학교 의과대학 서울아산병원 응급의학과
안신 ( Ahn Shin )
울산대학교 의과대학 서울아산병원 응급의학과
김원영 ( Kim Won-Young )
울산대학교 의과대학 서울아산병원 응급의학과
KMID : 0385920190300050428
Abstract
Objective: Although a left ventricular (LV) diastolic dysfunction is an important prognostic factor in myocardial dysfunction in septic shock, emergency departments (EDs) have limited capability of performing echocardiography. Cardiac troponin is a specific marker of a myocardial injury. On the other hand, little is known about the LV diastolic dysfunction in septic shock patients. This study examined the associations between troponin-I (TnI) level and LV diastolic dysfunction.
Method: A 5-year retrospective cohort study was conducted between January 2011 and December 2015, including adult septic shock patients who were treated with protocol-driven resuscitation bundle therapy and had the TnI tested at the ED. The LV diastolic dysfunction was defined as E/e′ratios above 15 in echocardiography.
Results: Of the 442 septic shock patients with an abnormal TnI (≥0.04 ng/mL) at admission, echocardiography was performed on 255 patients and 81 patients (31.8%) showed a LV diastolic dysfunction. The TnI level at ED admission was higher in the LV diastolic dysfunction group compared to the non-dysfunction group (0.08 [0.03-0.25] ng/mL vs. 0.14 [0.05-0.43] ng/mL, P=0.035). On the other hand, according to multivariate logistic regression and chronic kidney disease (odds ratio, 1.74; 95% confidence interval, 1.02-2.99) was the only factor associated with a LV diastolic dysfunction. Receiver operating characteristic analysis revealed the area under the curve of the initial TnI to be only 0.589 (P=0.038) and no correlation was observed between the initial TnI and E/e′(r=0.079, P=0.199).
Conclusion: A LV diastolic dysfunction occurred in approximately quarter of septic shock patients with TnI elevation, but the TnI test showed a weak association with diastolic dysfunction. Further studies will be needed to identify the predictors for a diastolic dysfunction in septic shock patients.
키워드
Troponin; Septic shock; Cardiomyopathies; Biomarkers; Organ failure
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